Adoption of assisted dying has rapidly grown, but many groups caution that these policies can cause suicide contagions. If those urging caution are correct, jurisdictions with these policies will experience increased suicides. This study aimed to determine the changes in population suicide rates in Belgium before and after its 2002 policy using the synthetic control method (SCM) and generalized synthetic control method (GSCM). As comparisons we used additional European Union members that have not adopted these policies. GSCM showed an average annual suicide rate increase of 0.73 per 100,000 population (95% CI - 5.7 to 7.2; p = 0.80). Placebo testing based on the SCM analysis showed equal outcomes for Belgium and the comparisons. This study failed to show evidence of association between implementation of legislation legitimizing assisted dying and population suicide rates. The threat of suicide contagion has influenced policy discussions in the past, but this study suggests that there is presently no indication for policy-makers to view suicide contagions as a concerning side effect of assisted dying legislation.
Background: This study compares a longitudinal population-based sample of spouses bereaved by suicide and those bereaved by other sudden deaths to determine if suicide-bereaved spouses (SBS) experience greater rates of physician-diagnosed mental disorders.
Methods: First, married individuals whose spouse died by suicide, sudden natural death (SND) and unintentional injury (UI) were compared to non-bereaved matched cohorts to determine if there were differences in mental disorder rates between bereavement groups and non-bereaved matches. Second, SBS (n = 365), spouses bereaved by SND (n = 1000), and spouses bereaved by UI (n = 270), were compared using inverse probability treatment weighting and generalized estimating equations to calculate relative rates of mental disorders 5 years before/after death.
Outcomes: All bereaved cohorts had higher rates of mental disorders compared to non-bereaved cohorts. SBS had the greatest rate of depression post-bereavement (50·96%), followed by UI (38·52%) and SND (33·70%) spouses. When comparing bereavement cohorts, a significant group-by-time interaction (P = 0·047) revealed the rate change for depression was significantly different between suicide and UI-bereaved spouses, with SBS having higher rates of depression before bereavement. SBS had increased rates of any mental disorder both pre (ARR = 1·35, 95% CI = 1·03-1·18, P<·05) and post spousal death (ARR = 1·24, 95% CI = 1·03-1·45, P<·05) when compared to UI spouses signifying pre-existing mental disorders. Post-bereavement, SBS had greater rates of depression only when compared to SND-bereaved spouses (ARR = 1·31, 95% CI = 1·10-1·55, P<·01). Interpretation: SBS have the greatest rates of depression and any mental disorder before the death of their spouse, suggesting suicide bereavement may be unique. Sudden spousal bereavement is a vulnerable time for mental disorders.
This column discusses the potential for conflict between the Federal laws forbidding the use of telecommunications to spread "suicide-related materials" and the laws in Victoria and Western Australia which have legalised forms of voluntary assisted dying. The column argues that the effect of the State laws is to differentiate the legal forms of voluntary assisted dying from suicide and assisted suicide, with the effect that Federal prohibitions do not apply to telecommunications between health practitioners and their patients regarding voluntary assisted dying.
Physician-assisted death for patients suffering from psychiatric disorders is allowed in the Netherlands under certain circumstances. One of the central problems that arise with regard to this practice is the question of whether it is possible to distinguish between suicidality and a request for physician-assisted death. We set up this study to gain insight into how psychiatrists and general practitioners distinguish between suicidality and physician-assisted death. The data for this study were collected through qualitative interviews with 20 general practitioners and 17 psychiatrists in the Netherlands. From the interviews, we conclude that physicians distinguish three types of death wishes among patients suffering from psychiatric disorders: 'impulsive suicidality,' 'chronic suicidality,' and 'rational death wishes.' To discern between them they evaluate whether the death wish is seen as part of the psychopathology, whether it is consistent over time, and whether they consider it treatable. Some considered physician-assisted death an alternative to a 'rational suicide,' as this was perceived to be a more humane manner of death for the patient and their relatives. We argue that physician-assisted death can be justified also in some cases in which the death wish is part of the psychopathology, as the patient's suffering can be unbearable and irremediable. Physician-assisted death in these cases may remain the only option left to relieve the suffering.
This study describes the characteristics of—and the counseling received by—counselees who passed away through self-ingesting self-collected lethal medication after receiving demedicalised assistance in suicide. We analyzed registration forms filled in by counselors working with Foundation De Einder about 273 counselees who passed away from 2011 to 2015. The majority of these counselees had a serious disease and physical or psychiatric suffering. Half of them had requested physician assistance in dying. This shows that patients with a denied request for physician assistance in dying can persist in their wish to end life. This also shows that not all people with an underlying medical disease request for physician assistance in dying. Physicians and psychiatrist are often uninvolved in these self-chosen deaths while they could have a valuable role in the process concerning assessing competency, diagnosing diseases, and offering (or referring for) treatment.
In this edition of the Canadian journal of psychiatry, van Veen and colleagues provide a thorough scoping review of the literature regarding physician-assisted death (PAD) in patients with a psychiatric disorder (PPD).
[Début de l'article]
The practice of medically assisted dying has long been contentious, and the question of what to call it has become increasingly contentious as well. Particularly among U.S. proponents of legalizing the practice, there has been a growing push away from calling it “physician-assisted suicide,” with assertions that medically assisted dying is fundamentally different from suicide. Digging deeper into this claim about difference leads to an examination of the difference between two kinds of suffering—suffering from physical conditions and suffering from psychological conditions—and therefore leads also toward an examination of whether requests for medical assistance in dying by those suffering from psychological conditions and those suffering from physical conditions should be painted with the same brush .
In this article, I aim both to illuminate some of the considerations that ought to be included in discussions related to medically assisted dying and to shed light on what the indirect effects of such discussions can be. I consider some of the reasons commonly given for holding that suicide and medically assisted dying differ fundamentally and then whether the conclusion that medically assisted dying should not be called “suicide” follows from the premises. I ask what else might justify the conclusion that the two acts ought to be called by different names, and I examine possible justifications for accepting this premise, as well as what justifications might exist for emphasizing how the acts are alike. Finally, I argue that we should be cautious before concluding that medically assisted dying should not be called “suicide.” We need more evidence either that the two acts are fundamentally different or that emphasizing differences between them is not likely to do more harm than good .
The varied physical, social, and psychological stressors that accompany advanced disease can be burdensome and cause intense emotional suffering, hindering the ability of patients and families to cope in day-to-day life and negatively affecting quality of life. This article addresses key concepts for the assessment and management of commonly encountered types of psychological distress in serious illness including grief, prolonged grief, major depressive disorder, death contemplation, and suicidal ideation.
Tiré du blog Tumblr "The last Message Received", créé par une adolescente de 16 ans, Emily Trunko, ce livre est "dédié à toutes les personnes qui, un jour, ont reçu un dernier message". Dans son introduction, Emily Trunko explique que le recueil de ces "derniers messages", messages de rupture amoureuse ou amicale pour certains, ou dernier message de cette "conversation légère dont tu ignores qu'elle précède une mort soudaine", a permis de fédérer une véritable communauté. Chaque dernier message choisi est accompagné de quelques lignes écrites par le destinataire, qui en retrace les circonstances.
Qu'il s'agisse de surmonter un deuil ou de prévenir un acte suicidaire, ce florilège de messages choisis ne laisse pas insensible et fait réfléchir à la portée de nos écrits. "Et si ce message était les derniers mots que mon destinataire lirait de moi ?" résonne alors comme un leitmotiv, une invitation à être plus prévenant et plus conscient des autres avant cet acte banal : cliquer sur "envoyer".
Several longitudinal studies show that over time the American public has become more approving of euthanasia and suicide for terminally ill persons. Yet, these previous findings are limited because they derive from biased estimates of disaggregated hierarchical data. Using insights from life course sociological theory and cross-classified logistic regression models, I better account for this liberalization process by disentangling the age, period, and cohort effects that contribute to longitudinal changes in these attitudes. The results of the analysis point toward a continued liberalization of both attitudes over time, although the magnitude of change was greater for suicide compared with euthanasia. More fluctuation in the probability of supporting both measures was exhibited for the age and period effects over the cohort effects. In addition, age-based differences in supporting both measures were found between men and women and various religious affiliations.
Many studies have highlighted the deleterious psychological impact of suicide on bereaved individuals. We examined the psychological processes facilitating posttraumatic growth (PTG) among 124 suicide-loss survivors, focusing on attachment styles, perceived burdensomeness, and thwarted belongingness. Securely attached individuals achieved higher PTG than insecurely attached individuals. Perceived burdensomeness and thwarted belongingness both mediated and moderated the associations between attachment and PTG. Anxiously or avoidantly attached individuals who also had a high level of perceived burdensomeness were the least likely to achieve PTG. Thus, these individuals may derive particular benefit from attachment-based therapeutic interventions focusing on interpersonal relationships.
Nous ferons d'abord dans ce chapitre un travail de précision sémantique qui apparaît nécessaire avant d'entrer dans le questionnement sur le suicide. Nous aborderons ensuite la question du rapport entre maladie grave et suicide, puis entre fin de vie et suicide et enfin entre suicide et soins palliatifs. Nous mènerons une réflexion spécifique sur le suicide à la fin de la vie des personnes âgées tant cette question doit être traitée spécifiquement.
[Extrait de l'Intro.]
Background: An important concern of healthcare professionals when exploring the wish to hasten death with patients is the risk of causing them some type of distress.
Aim: To assess the opinion of hospitalized patients with advanced cancer about the proactive assessment of the wish to hasten death.
Design: Descriptive, cross-sectional study.
Setting/participants: We assessed 193 advanced cancer patients admitted to an oncology ward for the wish to hasten death using a semi-structured clinical interview. After the assessment the participants were surveyed to determine whether they found the interview upsetting and, if so to what extent, and also their opinion regarding the assessment’s importance.
Results: The wish to hasten death was reported by 46 (23.8%) patients. The majority of patients (94.8%) did not find talking about the wish to hasten death to be upsetting, regardless of whether they presented it or not. The majority of patients (79.3%) considered that it was either quite or extremely important for the clinician to proactively assess the wish to hasten death and discuss this topic, regardless of whether they experienced it.
Conclusions: In this study, most of the advanced cancer patients did not find the assessment of wish to hasten death to be upsetting, and a substantial proportion of patients in this study believe that it is important to routinely evaluate it in this setting. These findings suggest that healthcare professionals can explore the wish to hasten death proactively in routine clinical practice without fear of upsetting patients.
Despite the alarming suicide rate among South Korean emerging adults, relatively little is known about their unfettered perspectives on death and suicide. Therefore, an innovative data collection technique was developed to apprehend the meanings that emerging adults attribute to death and suicide in their explorations of the phenomena through a selection of short stories. A convenience sample (N = 114) responded to a survey in which participants transferred their feelings toward death and suicide to characters or events in the short stories. A qualitative content analysis revealed relatively permissive perspectives toward death and suicide. Negative perspectives on death are associated with societal victimization and positive perspectives with naturalistic fatalism. Positive perspectives on suicide are overwhelmingly rooted in existential, individual choices while negative perspectives focus on societal pressures. These perspectives contribute to illuminating tensions between traditionalist collectivism and contemporary individualism in Korean society that could inform suicide prevention initiatives for emerging adults.
CONTEXT: Many jurisdictions around the world have passed medical aid in dying laws allowing competent, eligible individuals facing life-limiting illness to self-administer prescribed medication to control timing of death. These laws do not prevent some patients who are receiving hospice services from dying by suicide without assistance.
OBJECTIVES: To explore hospice professionals' experiences of patients who die by suicide or intentionally hasten death with or without legal assistance in an area where there is legalized medical aid in dying.
METHODS: Semi-structured in-depth qualitative interviews were conducted with twenty-one home hospice professionals (7 nurses, 7 social workers, 4 physicians, 3 chaplains). Thematic analysis was carried out to analyze the data.
RESULTS: Three primary themes were identified from the interviews: 1) dealing with and differentiating between hastened death and suicide, 2) medical aid in dying access and affordability, and 3) how patients have hastened their own deaths. Analysis of these data indicates there are some patients receiving hospice services who die by suicide because they are not eligible for, have no knowledge of, or lack access to legalised medical aid in dying. Hospice professionals do not consistently identify patients' deaths as suicide when they are self-inflicted and sometimes view these deaths as justified.
CONCLUSION: Suicide and hastened deaths continue to be an unexamined cause of death for some home hospice patients who may have requested medical aid in dying. Open communication and increased education and training is needed for palliative care professionals regarding legal options, issues of suicide and suicide assessment.
Despite the increasing number of people being bereaved by suicide, little is understood concerning the experiences of those bereaved by suicide as they struggle to make sense of a loved one’s death. The current study explored the experiences of four mothers who had been bereaved by suicide and the role of support groups in the meaning-making process following bereavement by suicide. Participants were interviewed and transcribed interviews were then analysed from an interpretative phenomenological perspective. Four main themes were identified: Continuing role of the mother; A never-ending quest; Finding sanctuary; and Rising up from the ashes. These themes relate to a range of emotions following bereavement by suicide, the meaning-making process, the social context and the role of the support group. Clinical implications are discussed in relation to these findings.
The United States military began to experience a steady increase in suicide rates across all service branches at the inception of the wars in Afghanistan (2001) and Iraq (2003). As the number of suicide deaths increased, so did the number of affected survivors who seek postvention support. Unique issues that accompany suicide death may expose survivors to a more distressing and complicated grief process. Peer support has clinically been observed to be widely utilized by suicide loss survivors. This article explores unique issues accompanying military suicide loss, potential benefits of postvention peer-based support, clinical considerations, and future directions.
This article chronicles the process of reducing the 10 week restorative retelling (RR) group model (Rynearson & Correa, Accommodation to violent dying: A guide to restorative retelling and support, Violent Death Bereavement Society, 2006) into a 3 day retreat for families of homicide loss. Strategies used to address the intensity of the condensed version of the treatment model are described for both the participants and treatment team. The twists and turns of how the therapeutic retreat unfolded are presented through case examples. The authors explicate the risks and rewards of conducting the RR model at speed, identify the challenges they faced, and give impressions for overall treatment efficacy.
Reenactment imagery that remains fixating after violent dying is associated with diminished psychological resilience. The nonresilient teller struggles to maintain an integrative orientation within the recounting. Reestablishing the resilient capacities of pacification (mastery of terror through self-calming), partition (mastery of intrusive thoughts through self-differentiation), and perspective (mastery of self-determination through self-transcendence) is an important preparatory goal with intervention. Without these resilient capacities, premature exposure increases the risk that patients will experience a dysfunctional merger with the possessive reenactment representation. A preliminary model of resilient “offenses” to be reinforced in the traumatized subject as a first stage of intervention is presented.
The purpose of this qualitative study was to explore the characteristics of posttraumatic growth arising from losing an immediate family member to suicide in Korea. We used interpretative phenomenological analysis for data collection and analysis and conducted in-depth interviews with 11 participants in Korea to evaluate the positive changes subsequent to the suicide. Participants revealed positive outcomes in response to losing an immediate family member to suicide after suffering the “most unimaginable pain” including (a) “Now I know what the most important thing in life is,” (b) “Warm and intimate relationships matter,” and (c) “Survivors of suicide’s search for meaning.” The implications of these findings and avenues for future research are discussed.